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Antibiotics and Alcohol Risks and Interactions

Medically reviewed by Dr. Po-Chang HsuNovember 7, 2024
Written by
On November 7, 2024

Table of Contents

Key Points

  • Many antibiotics shouldn’t be mixed with alcohol because of the risk of serious side effects.
  • Other antibiotics can have a serious risk of liver damage if you drink alcohol while taking them.
  • Alcohol can make certain antibiotics less effective or may impact your body’s ability to fight infections the antibiotic treats.
  • If you misuse alcohol or are addicted to it, talk to your doctor before stopping suddenly to avoid withdrawal symptoms, which can be dangerous.

Some antibiotics are safe to mix with alcohol, but combining others can significantly increase your chances of developing side effects. In some cases, drinking alcohol while on antibiotics can make the antibiotic less effective and negatively impact your health.

Learn more about which antibiotics shouldn’t be mixed with alcohol and what effects they can have.

Antibiotics You Shouldn’t Mix with Alcohol

You should never combine cefoperazone, cefotetan, metronidazole, tinidazole, ketoconazole, isoniazid, linezolid, or griseofulvin antibiotics with alcohol.[1] Doing so can cause potentially serious reactions like:[2]

  • Nausea
  • Vomiting
  • Flushing
  • Headache
  • Fast heartbeat
  • Stomach cramps

 

You shouldn’t use alcohol before, during, or for at least 3 days after taking these drugs.

Disulfiram-Like Reactions with Alcohol and Antibiotics

One of the most well-known interactions between alcohol and antibiotics is with the antimicrobial agent metronidazole (Flagyl). Metronidazole is often used for bacterial infections of the stomach, intestine, skin, joints, and lungs. Taking metronidazole with alcohol may cause a disulfiram-like reaction when the antibiotic inhibits aldehyde dehydrogenase (ALDH), leading to an increased concentration of acetaldehyde.[3] 

The symptoms of a disulfiram-like reaction may include:[4]

  • Nausea
  • Vomiting
  • Flushing of the skin
  • Stomach cramps
  • Headache
  • Chest pain
  • Rapid heart rate
  • Difficulty breathing

 

A similar severe reaction can occur with tinidazole (Tindamax) and cefotetan (Cefotan), which are in the same class as metronidazole.[5] You shouldn’t consume alcohol for at least 72 hours after taking these medications.

Central Nervous System Side Effects

Alcohol is a central nervous system (CNS) depressant. Certain antibiotics can cause CNS side effects, such as metronidazole, that may include drowsiness, sedation, dizziness, and confusion. When alcohol is combined with antibiotics that depress the CNS, the additive effects can lead to severe drowsiness that can cause injury or death.[6] You should also avoid other CNS depressants like opioids or muscle relaxants on these antibiotics.

Stomach and Liver Side Effects

Stomach side effects like nausea, vomiting, severe diarrhea, and stomach pain can occur with certain antibiotics. Consuming alcohol with these antibiotics can worsen the effects.

Excessive alcohol use can cause liver damage like cirrhosis. If you take antibiotics that can also affect the liver, the effects can be compounded. The symptoms of liver damage may include fever, chills, joint pain, swelling, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark-colored urine, pale-colored stools, yellowing of the skin or eyes, and unusual bleeding or bruising.[7]

Can Alcohol Make Antibiotics Less Effective?

Alcohol doesn’t directly affect how well most antibiotics work, but it can interfere with certain antibiotics’ effectiveness or exacerbate side effects. Liver enzymes metabolize alcohol. Liver enzymes metabolize some drugs, so the liver’s work in metabolizing both substances can affect how well the antibiotic is broken down.[8]

For example, if you binge drink while taking antibiotics, your liver may be overwhelmed and unable to metabolize the drug efficiently. The levels of the antibiotic may increase because it can’t be metabolized and excreted effectively, leading to side effects and possible toxicity.

Similarly, if you use alcohol regularly, enzyme levels can be induced. This means the drug is being broken down more quickly, decreasing the levels of antibiotics in your blood. Antibiotic courses are dosed out appropriately to avoid toxic effects while also treating the infection, so this can cause your infection not to be cured or for antibiotic resistance to develop.

Effects of Alcohol on the Healing Process

Drinking alcohol may not always affect how well an antibiotic works, but it can interfere with your body’s ability to heal the infection the antibiotic is intended to treat.[9] For example, resting and eating well are important to avoid a weakened immune system and help your body recover. Alcohol can disrupt your sleep patterns and may disrupt your body’s nutrient absorption. These factors can reduce the body’s ability to heal from an infection.

Do You Always Need to Avoid Drinking Alcohol with Certain Antibiotics?

It depends on the antibiotic and your general health. It’s important to talk to your doctor or pharmacist to see if alcohol and the specific antibiotic are safe together.

How to Avoid Adverse Effects of Antibiotics and Alcohol

Antibiotics come with instructions and warning labels that tell you what to avoid while taking them, including supplements, over-the-counter and prescription medications, and substances like alcohol. If your antibiotic has a warning against drinking alcohol while you’re taking it, it’s best to avoid alcohol until your round is complete.

Make sure you talk to your doctor or pharmacist if you’re unsure about the medication restrictions. Sometimes, an occasional drink may be safe with your antibiotic, but there are individual factors to consider. Your doctor can evaluate your age, overall health, and the type of antibiotic you’re taking to advise you if the combination is generally safe with alcohol.

Understanding Alcohol Abuse and Addiction

If you only consume alcohol on occasion, you should be able to stop drinking for the short period that you’re on antibiotics to let them run their course. However, if you abuse alcohol or have an alcohol addiction, stopping alcohol use can be difficult, if not dangerous. 

Alcohol use is legal and commonplace, but it’s still an addictive substance. If you drink alcohol regularly, dependence can occur quickly. This means that your body is used to the presence of alcohol and needs it to function properly. If you stop suddenly, withdrawal can occur with symptoms like:[10]

  • Anxiety
  • Headache
  • Nausea
  • Vomiting
  • Shaky hands
  • Insomnia
  • Sweating
  • Confusion
  • Racing heart
  • High blood pressure
  • Fever
  • Delirium tremens
  • Seizures

Alcohol withdrawal can be dangerous, so it’s important that you don’t stop drinking suddenly if you’re dependent. Depending on the extent of your abuse or addiction, you may need treatment with medical detox and a comprehensive recovery program at an alcohol rehab center. Talk to your doctor if you have concerns about stopping alcohol, and take an antibiotic to discuss treatment options.

Take Precautions with Alcohol and Antibiotics

Mixing alcohol and antibiotics is not a good idea in general. Alcohol and antibiotics can have side effects, some of which are severe, and drinking alcohol while taking an antibiotic can increase the potential harm. In addition, alcohol affects your body’s ability to heal and may render some antibiotics less effective, so it’ll take longer for you to heal from your infection.

Medical Content Writer

Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.

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Frequently Asked Questions About Antibiotics and Alcohol

There is no known interaction between alcohol and amoxicillin, but mixing amoxicillin with alcohol or other drugs can still have effects. Drinking alcohol while taking amoxicillin can worsen some of the side effects, like stomach discomfort and nausea.

Some antibiotics can cause side effects when combined with alcohol, including nausea, vomiting, stomach pain, flushing, and liver damage. Alcohol can also affect how antibiotics are metabolized and how well they can treat your infection.

Doxycycline shouldn’t be taken with alcohol because it can reduce the blood levels of the antibiotic and may affect how well it works. The effects can last for days after stopping alcohol use.

Several antibiotics shouldn’t be mixed with alcohol, including metronidazole, tinidazole, and sulfamethoxazole-trimethoprim. Drinking alcohol with these antibiotics can cause severe side effects like nausea, vomiting, headache, and fast heart rate.

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[1,2] Roland, J. (2023, April 20). Combining antibiotics and alcohol: Is it safe?. Healthline. Retrieved from https://www.healthline.com/health/antibiotics-alcohol#antibiotics-and-alcohol on 2024, October 3.

[3,4,5,6,7,8] Can you drink alcohol with antibiotics?. Drugs.com. (n.d.-b). Retrieved from https://www.drugs.com/article/antibiotics-and-alcohol.html#reaction on 2024, October 3.

[9] Roland, J. (2023, April 20). Combining antibiotics and alcohol: Is it safe?. Healthline. Retrieved from https://www.healthline.com/health/antibiotics-alcohol#antibiotics-and-alcohol on 2024, October 3.

[10] WebMD. (n.d.-b). Alcohol withdrawal: Symptoms, treatment and alcohol detox duration. WebMD. Retrieved from https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments on 2024, October 3.

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